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Conference Paper: THE EFFECT OF EARLY MEDICATION DISCONTINUATION ON LONG-TERM CLINICAL OUTCOME IN FIRST EPISODE PSYCHOSIS
Title | THE EFFECT OF EARLY MEDICATION DISCONTINUATION ON LONG-TERM CLINICAL OUTCOME IN FIRST EPISODE PSYCHOSIS |
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Authors | |
Issue Date | 2018 |
Publisher | Oxford University Press. The Journal's web site is located at http://schizophreniabulletin.oxfordjournals.org/ |
Citation | The Sixth Biennial Schizophrenia International Research Society (SIRS) Conference: Integrated Prevention and Treatment: Shifting the Way We Think, Florence, Italy, 4–8 April 2018. In Schizophrenia Bulletin, 2018, v. 44 n. Suppl. 1, p. S97, abstract no. O8.4 How to Cite? |
Abstract | Background: Clinical decision to dis/continue antipsychotics in patients remitted from first-episode psychosis is important. Existing short-term evidence suggests that patients who discontinued antipsychotics had more relapses. Data on long-term outcomes are lacking; with only one open-label study suggesting better long-term recovery outcome in patients who had early medication discontinuation. We examined the long-term effect of early medication discontinuation in year 2 following first-episode remission for patients with no residual psychotic symptoms.
Methods: We followed-up 178 first-episode psychosis patients who participated in a 1-year randomized controlled trial (RCT) on medication discontinuation. Patients were randomized into receiving either a medication maintenance group or a placebo discontinuation group. After the RCT, all patients received usual psychiatric care. Poor long-term clinical outcome was defined as a composite of persistent psychotic symptoms, a requirement for clozapine, or suicide.
Results: There were no differences between patients who were included (n=142) and excluded (n=36) from the study with regard to their baseline demographics, clinical and functioning. At 10 years, more patients in the early discontinuation group (35/89, 39%) had poor clinical outcome than patients in the maintenance group (19/89, 21%) (P<0.01). Relapse during the RCT has partly mediated the significant relationship between early medication discontinuation and poor outcome at 10-year.
Discussion: Whether to discontinue medication following successful treatment of first episode psychosis is a difficult clinical decision. In first episode psychosis with a full initial response to antipsychotic treatment, continued need for medication is important for the first three years after starting treatment, to prevent relapse, and decrease the risk for a poor long-term outcome. |
Description | Issue Section: J O8. Oral Session: Outcome |
Persistent Identifier | http://hdl.handle.net/10722/312239 |
ISSN | 2023 Impact Factor: 5.3 2023 SCImago Journal Rankings: 2.249 |
DC Field | Value | Language |
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dc.contributor.author | Chen, EYH | - |
dc.contributor.author | Hui, CLM | - |
dc.contributor.author | Chang, WC | - |
dc.contributor.author | Chan, KW | - |
dc.contributor.author | Lee, HME | - |
dc.contributor.author | Honer, W | - |
dc.date.accessioned | 2022-04-25T01:37:03Z | - |
dc.date.available | 2022-04-25T01:37:03Z | - |
dc.date.issued | 2018 | - |
dc.identifier.citation | The Sixth Biennial Schizophrenia International Research Society (SIRS) Conference: Integrated Prevention and Treatment: Shifting the Way We Think, Florence, Italy, 4–8 April 2018. In Schizophrenia Bulletin, 2018, v. 44 n. Suppl. 1, p. S97, abstract no. O8.4 | - |
dc.identifier.issn | 0586-7614 | - |
dc.identifier.uri | http://hdl.handle.net/10722/312239 | - |
dc.description | Issue Section: J O8. Oral Session: Outcome | - |
dc.description.abstract | Background: Clinical decision to dis/continue antipsychotics in patients remitted from first-episode psychosis is important. Existing short-term evidence suggests that patients who discontinued antipsychotics had more relapses. Data on long-term outcomes are lacking; with only one open-label study suggesting better long-term recovery outcome in patients who had early medication discontinuation. We examined the long-term effect of early medication discontinuation in year 2 following first-episode remission for patients with no residual psychotic symptoms. Methods: We followed-up 178 first-episode psychosis patients who participated in a 1-year randomized controlled trial (RCT) on medication discontinuation. Patients were randomized into receiving either a medication maintenance group or a placebo discontinuation group. After the RCT, all patients received usual psychiatric care. Poor long-term clinical outcome was defined as a composite of persistent psychotic symptoms, a requirement for clozapine, or suicide. Results: There were no differences between patients who were included (n=142) and excluded (n=36) from the study with regard to their baseline demographics, clinical and functioning. At 10 years, more patients in the early discontinuation group (35/89, 39%) had poor clinical outcome than patients in the maintenance group (19/89, 21%) (P<0.01). Relapse during the RCT has partly mediated the significant relationship between early medication discontinuation and poor outcome at 10-year. Discussion: Whether to discontinue medication following successful treatment of first episode psychosis is a difficult clinical decision. In first episode psychosis with a full initial response to antipsychotic treatment, continued need for medication is important for the first three years after starting treatment, to prevent relapse, and decrease the risk for a poor long-term outcome. | - |
dc.language | eng | - |
dc.publisher | Oxford University Press. The Journal's web site is located at http://schizophreniabulletin.oxfordjournals.org/ | - |
dc.relation.ispartof | Schizophrenia Bulletin | - |
dc.relation.ispartof | The Sixth Biennial Schizophrenia International Research Society (SIRS) Conference | - |
dc.title | THE EFFECT OF EARLY MEDICATION DISCONTINUATION ON LONG-TERM CLINICAL OUTCOME IN FIRST EPISODE PSYCHOSIS | - |
dc.type | Conference_Paper | - |
dc.identifier.email | Chen, EYH: eyhchen@hku.hk | - |
dc.identifier.email | Hui, CLM: christyh@hku.hk | - |
dc.identifier.email | Chang, WC: changwc@hku.hk | - |
dc.identifier.email | Chan, KW: kwsherry@hku.hk | - |
dc.identifier.email | Lee, HME: edwinlhm@hku.hk | - |
dc.identifier.authority | Chen, EYH=rp00392 | - |
dc.identifier.authority | Hui, CLM=rp01993 | - |
dc.identifier.authority | Chang, WC=rp01465 | - |
dc.identifier.authority | Chan, KW=rp00539 | - |
dc.identifier.authority | Lee, HME=rp01575 | - |
dc.description.nature | abstract | - |
dc.identifier.doi | 10.1093/schbul/sby015.240 | - |
dc.identifier.hkuros | 332844 | - |
dc.identifier.volume | 44 | - |
dc.identifier.issue | Suppl. 1 | - |
dc.identifier.spage | S97, abstract no. O8.4 | - |
dc.identifier.epage | S97, abstract no. O8.4 | - |
dc.publisher.place | United Kingdom | - |